MAJOR metropolitan hospitals are taking longer to process patients through their emergency departments than their country counterparts.
And regardless of their location, smaller hospitals are generally outperforming bigger ones, according to the first report from the new National Health Performance Authority.
State and territory governments have agreed to a national target which will require 90 per cent of all patients to leave emergency departments within four hours by 2015.
With two years to go there's a lot of work to do.
In major metropolitan hospitals just 54 per cent of patients were admitted or discharged within four hours in 2011/12.
In regional areas the figure was 63 per cent.
When it came to large hospitals - which are smaller than those classified as major - those in metropolitan areas again performed worse (67 per cent) compared with equivalent-sized regional hospitals (78 per cent).
In medium hospitals Australia-wide about 76 per cent of patients were processed within four hours.
The best performing major metro hospital was Fremantle at 74 per cent. Others in the top 10 per cent were Royal Perth, Casey in Victoria and Sir Charles Gairdner and Joondalup, both in Western Australia.
The worst major metro hospital was Princess Alexandra in Brisbane at just 33 per cent. That was the lowest figure for all hospitals. Other major metropolitan hospitals in the bottom 10 per cent were Liverpool, Blacktown and Westmead in NSW and Western Hospital in Victoria.
The highest achiever from any category was the medium-sized Williamstown Hospital in Victoria where 93 per cent of patients left emergency within four hours.
"The performance of an emergency department and the percentage of patients that leave within four hours is very much related to the size of the hospital and also location," NHPA chief executive Diane Watson said.
"Much more so than the characteristics and features of its emergency department."
Dr Watson said national reporting would allow lessons to be learnt that "transcend state boundaries".
The federal government hopes poor performers can adopt the better practices of those hospitals that are excelling.
There are large variations between hospitals but Dr Watson notes a number are already exceeding existing state targets.
"We'll track their progress and expect by 2015 that 90 per cent of all patients will be leaving emergency departments within four hours," she said.
The report was based on data from 122 major, large and medium-sized public hospitals. A further 12 specialist hospitals contributed statistics but weren't compared.
There were four million visits to emergency departments at major metro and regional hospitals in 2011/12. Overall, the country's 134 public hospitals had 5.9 million presentations